What are the treatment options for Proteus infections?

Updated: Mar 03, 2020
  • Author: Shirin A Mazumder, MD, FIDSA; Chief Editor: Michael Stuart Bronze, MD  more...
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Cultures with susceptibility data are recommended, when available, to guide antimicrobial therapy. Most Proteus strains are susceptible to commonly used antibiotics, except nitrofurantoin and tetracycline. Like other members of Enterobacteriaceae, multidrug-resistant (MDR) strains of Proteus exist and are increasing in frequency; strains of P vulgaris are generally more resistant.

Recommended empirical treatment includes the following:

  • Uncomplicated UTIs in women can be treated on an outpatient basis with an oral quinolone for 3 days or trimethoprim/sulfamethoxazole (TMP/SMZ) for 3 days.

  • Acute uncomplicated pyelonephritis in women can be treated with oral quinolones for 7-14 days, single-dose ceftriaxone or gentamicin followed by TMP/SMZ, or an oral cephalosporin or quinolone for 14 days as outpatient therapy. For hospitalized patients, therapy consists of parenteral (or oral once the oral route is available) ceftriaxone, quinolone, gentamicin (plus ampicillin), or aztreonam until defervescence. Then, an oral quinolone, cephalosporin, or TMP/SMZ for 14 days may be added to complete treatment.

  • Complicated UTIs in men and women can be treated with a 10- to 21-day course of oral therapy (in the same manner as for hospitalized patients) as long as the follow-up is adequate.

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